Cardiology Roundup: Noninvasive Imaging Tests May Be Best


Cardiac imaging continues to transform the practice of medicine and improve patient care. Advancements in noninvasive diagnostic imaging can offer safer alternatives — if not outright replacements — for invasive procedures. That’s welcome news for patients and physicians alike.

In this roundup you will find a new imaging management algorithm to help determine which tests to use when diagnosing coronary artery disease. Other researchers detail how they address complex cardiac cases through 3D printing and computer aided design. You also will get a high-level picture of future payment models proposed by the American College of Cardiology and Duke-Margolis Center for Health Policy. Read on to learn more about the continued evolution of cardiac imaging.

1. Should Noninvasive Cardiac Imaging Tests Replace Invasive Ones?

Imaging tests for coronary artery disease have changed dramatically over the past 20 years, prompting a re-evaluation of which ones to use and when, according to a recently published paper by the online open access site, Dovepress.

In routine clinical practice, the diagnosis of significant coronary artery disease is typically made during invasive coronary angiography. Newer, noninvasive tests are likely to be better options in the future, the authors said.

The researchers review state-of-the-art noninvasive imaging for assessing stable coronary artery disease and provide an up-to-date analysis of today’s literature and current management options. Based on this information, they propose a management algorithm for deciding which imaging tests may be most appropriate for patients with low, intermediate or high pretest probability of coronary artery disease.

2. Proposed Payment Reforms Encourage Collaboration Between Cardiology and Primary Care

As CMS has cancelled their proposed mandatory bundled cardiac payment models, the future of reimbursement looks to be more voluntary and collaborative.

In this article, the American College of Cardiology and the Duke-Margolis Center for Health Policy propose three new payment models to support more effective collaboration between cardiologists and primary care physicians. The models were created specifically for treating patients with chronic cardiovascular disease, but could be useful in other areas.

In a summary of the recently published paper, a clinician-to-clinician consultation model is detailed along with one for multispecialty care coordination. In addition, a payment model also is proposed for the long-term care of advanced chronic cardiovascular disease.

3. Researchers detail trends of increasing heart failure in the UK

The number of heart failure cases has risen significantly in the U.K., according to a new study in the Lancet. From 2002 to 2014 the estimated total number of heart failure cases rose 23%. The estimated number of individuals with newly diagnosed heart failure rose 12%.

Researchers attributed these overall gains to an aging and growing population, as well as increasing survival rates. They also observed that prevention and treatment of heart failure is becoming more complex as more people with heart failure also have other chronic conditions. The researchers reviewed EMR data from a nationally representative sample of 3.9 million people.

“Our findings have important implications for healthcare resource planning and prevention strategies, as the number of people affected by heart failure grows and places an ever-greater burden on health services,” says Professor Kazem Rahimi, The George Institute for Global Health, the University of Oxford, UK, in a press release.

4. ACC Survey: Burnout pervasive in cardiologists

An American College of Cardiology survey found 27% of U.S. cardiologist reported feeling burnout. Two-thirds of cardiologists with constant burnout symptoms or complete burnout cited excessive time spent completing their electronic medical records as a significant contributing factor.

Armed with the survey results, ACC leadership is redefining the organization’s mission statement to incorporate a new emphasis on providing for physician health and well-being in addition to the more traditional goals of improving the quality and reducing the cost of care.

5. Who uses CCTA more: radiologists or cardiologists?

Radiologists are using coronary CT angiography (CCTA) more than cardiologists, according to a new study.  Researchers found that in 2007, cardiologists’ utilization of CCTA was about twice that of radiologists, but by 2015 utilization by radiologists was 38% higher than that of cardiologists.

This is a stark reversal from a decade ago, when cardiologists performed more cardiac catheterizations than radiologists.

6. Applications in cardiology for 3D printing and computer aided design

Cardiology is leveraging 3D printing and computer aided design (CAD) to help avoid complications during surgery and to speed development of new transcatheter technologies. Dee Dee Wang, M.D., Director of Structural Heart Imaging at Henry Ford Hospital, Detroit, explains in this video how her center uses 3D printing and CAD software to better determine the right valve size for the heart prior to surgery. The technologies also are being used to give physicians a clearer picture of what issues may arise during complex surgeries and for hands-on clinical education.

Technology continues to transform cardiac imaging and improve patient care as it expands opportunities for noninvasive diagnostic imaging and enters new territory with 3D printing and CAD. At the same time, new reimbursement models are being explored to support more coordinated patient care. As the profession continues to evolve, cardiologists will need to stay alert to changes both in technology and process, always with an eye toward more efficient, higher-quality patient care.

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